title: Referral and counter-referral system between secondary and tertiary care facilities in a children's hospital network of Greater Buenos Aires.
abstract: Hospital El Cruce is a tertiary care facility which is part of a healthcare network that has been operating since July 2008 and includes health centers from five municipalities of the South of Greater Buenos Aires. The objective of the study was to describe the referral and counter-referral system at the pediatric intermediate medical care unit of the Hospital El Cruce, the tertiary level care of the network, and secondly to identify the critical points that could go against the consolidation of the network and to analyze the level of knowledge about it.
  
  
  
  This was a cross-sectional, prospective study conducted at the pediatric intermediate medical care unit of Hospital El Cruce between July 2008 and December 2010. Indicators related to patient admission and discharge were analyzed. A survey was administered to all the heads of the network's pediatric departments in order to assess the level of knowledge they had about it.
  
  
  
  A total of1677patients were hospitalized; 83.9% were referred from the network. Of all referrals made, 71.1% were accepted. There were 156 patients (9.4%) who were counter-referred to the referring facility. The survey results showed that 70% of heads of pediatric departments were unaware of the range of services provided by the network.
  
  
  
  Health care exchange was predominantly based on accepting patients referred from secondary care facilities to Hospital El Cruce and a minimum number of counter-referrals to referring facilities, with a radial pattern dynamics. There was scarce knowledge about the availability of the network health service delivery.
authors.affiliation: Hospital El Cruce Dr. Néstor Kirchner, Buenos Aires, Argentina.
authors.forename: Pablo
authors.initials: P
authors.lastname: García Munitis
authors.forename: Maximiliano
authors.initials: M
authors.lastname: de Abreu
authors.forename: Laura
authors.initials: L
authors.lastname: Antonietti
authors.forename: Mercedes
authors.initials: M
authors.lastname: Guillén
authors.forename: Matías
authors.initials: M
authors.lastname: Said
authors.forename: César
authors.initials: C
authors.lastname: Montali
authors.forename: Natalia
authors.initials: N
authors.lastname: Arrospide
authors.forename: Guillermo
authors.initials: G
authors.lastname: Barbero
authors.forename: Diego
authors.initials: D
authors.lastname: Cerrudo
authors.forename: Estela
authors.initials: E
authors.lastname: Parodi
authors.forename: Cinthia
authors.initials: C
authors.lastname: Amato
authors.forename: Marcelo
authors.initials: M
authors.lastname: Pereira
mesh_terms: D000293:Adolescent; D001118:Argentina; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D063728:Secondary Care Centers / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D014504:Urban Health